| NPI | 1871741975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: FL MH829) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL MT585) |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2008-09-03 |